Surgeons occasionally encounter a patient with a gastric cancer invading an adjacent organ, such as the pancreas, liver, or transverse colon. Although there is no established guideline for treatment of invasive gastric cancer, combined resection with radical gastrectomy is conventionally performed for curative purposes. We recently treated a patient with a large gastric cancer invading the abdominal wall, which was initially diagnosed as a simple abdominal wall abscess. Computed tomography showed that an abscess had formed adjacent to the greater curvature of the stomach. During surgery, we made an incision on the abdominal wall to drain the abscess, and performed curative total gastrectomy with partial excision of the involved abdominal wall. The patient received intensive treatment and wound management postoperatively with no surgery-related adverse events. However, the patient could not receive adjuvant chemotherapy and expired on the 82nd postoperative day.
Abdominal Wall* ; Abscess* ; Chemotherapy, Adjuvant ; Colon, Transverse ; Gastrectomy ; Humans ; Liver ; Neoplasm Invasiveness ; Pancreas ; Stomach ; Stomach Neoplasms* ; Stomach Rupture ; Surgeons ; Wounds and Injuries

PURPOSE: The postoperative treatment after appendectomy is usually decided on the basis of the surgeons' intraoperative findings. Comparatively, the pathologic diagnosis of appendicitis is confirmed several days after the surgery; therefore, it usually does not affect the postoperative treatment strategy. The aim of this study was to investigate the discrepancies between the surgical and pathologic diagnoses of appendicitis and to identify their clinical implication. METHODS: A retrospective observational study was performed in 1,817 patients who underwent 3-port laparoscopic appendectomy for the final diagnosis of appendicitis. The clinical variables that could estimate the severity of appendicitis and the intensity of postoperative treatment were analyzed and compared according to the surgical and pathologic diagnoses. RESULTS: Of 1,321 cases of surgically simple appendicitis, 254 (29.3%) were pathologically complicated appendicitis. On the other hand, 221 of 496 cases (44.5%) of surgically complicated appendicitis were pathologically simple. Neither the surgical nor the pathologic diagnosis of appendicitis affected the development of postoperative intra-abdominal abscess (P = 0.079 for surgical diagnosis; P = 0.288 for pathologic diagnosis); however, the surgical diagnosis showed more correlation with the severity of disease and the intensity of the treatment pathway than did the pathologic diagnosis. CONCLUSION: There were discrepancies between the surgeons' intraoperative assessment and the pathologists' final histologic diagnosis of appendicitis. The surgeon's classification might be more predictive of the outcome than the pathologist's because only the surgeon's findings are available immediately after surgery.

Background: This study aims to measure regional healthcare differences in Korea, and define relatively underserved areas. Methods: We employed position value for relative comparison index (PARC) to measure the healthcare status of 250 areas using 137 indicators in five following domains: healthcare demand, supply, accessibility, service utilization, and outcome. We performed a sensitivity analysis using t-SNE (t-distributed stochastic neighboring embedding). Results: Based on PARC values, 83 areas were defined as relatively underserved areas, 49 of which were categorized as moderate and 34 as severe. The provincial regions with the most underserved areas were Gyeongbuk (16 areas), Gangwon (13), Jeonnam (13), and Gyeongnam (12). Conclusion This study suggests a relative comparison approach to define relatively underserved areas in healthcare. Further studies incorporating various perspectives and methods are required for policy implications.

This study aimed to update suicide-related indicators including suicidal ideation, suicide attempts, and the number of suicidal deaths.Based on up-to-date information, we observed the trends of suicide-related indicators. In this study, five data sources were used to observe the trends of suicide-related indicators: Statistics Korea (1983–2019), Korean National Health and Nutrition Examination (KNHANES, ‘07–13, ‘15–19), Korean Community Health Survey (KCHS, ‘08–09, ‘13, ‘17), Korean Wealth Panel Study (KOWEPS, ‘12–19), and Korea Health Panel Survey (KHP, ‘10–13, ‘16-17). The suicide rate, which peaked in 2011, declined until 2017 and then started to rise again from 2018, recording a suicide rate of 26.9 per 100,000 people in 2019. The rate of suicidal ideation estimated based on the recently available data was 4.62% (KNHANES, ‘19), 3.51% (KHP, ‘16), 2.87% (KHP, ‘17), and 1.70% (KOWEPS, ‘19). That of suicide attempt as recent year was 0.43% (KNHANES, ‘19), 0.07% (KOWEPS, ‘19). Annual percentage change of death by intentional self-harm was -2.11% (Statistics Korea), and that of suicidal ideation was -14.7% (KNHANES), -2.5% (KCHS), -10.6% (KOWEPS), and -11.3% (KHP). Annual percentage change of suicide attempt was -5.0% (KNHANES), -4.4% (KCHS), and -11.3% (KOWEPS). The lower the income level, the higher the probability of experiencing suicide ideation and suicide attempts. Considering the recent increase in suicide rate in contrast to the continuing decline in suicidal ideation and suicide attempts, continuous data observation and appropriate policies regarding suicide prevention are needed.

Suicide is a major public health issue that causes over 800,000 deaths each year globally. Korea ranks high in suicide rates, in which around 24.3 per 100,000 individuals are reported to have died by intentional self-harm in 2017 according to Statistics Korea. The aim of this study was to examine the current status and trend of suicide ideation and attempt using data from the following five sources: Korean National Health and Nutrition Examination (KNHANES, ‘07–13, ‘15–17), Korean Community Health Survey (KCHS, ‘08–09, ’13, ’17), Korean Wealth Panel Study (KOWEPS, ‘12–17), Korea Health Panel Survey (KHP, ‘10–13), and Statistics Korea (1983–2017). Suicide ideation and attempts were also further examined based on equalized household income levels. Data published by Statistics Korea were used to show the updated suicide rate and number of deaths by intentional self-harm. The rate of suicide ideation at the recent year was 4.73% (KNHANES, ‘17), 6.96% (KCHS, ‘17), 1.63% (KOWEPS, ‘17), and 5.39% (KHP, ‘13). That of suicide attempts as recent year was 0.71% (KNHANES, ‘17), 0.32% (KCHS, ‘17), and 0.09% (KOWEPS, ‘17). Annual percentage change of suicidal ideation was −15.4% (KNHANES, ‘07–17), −2.5% (KCHS, ‘08–17), −8.6% (KOWEPS, ‘12–17), and −10.9% (KHP, ‘10–13). Annual percentage change of suicide attempts was −4.0% (KNHANES, ‘07–17), −4.4% (KCHS, ‘08–17), and −14.9% (KOWEPS, ‘12–17). Individuals with lower income levels were more likely to experience suicide ideation and attempts. Considering that Korea still shows a high suicide rate despite the continuously decreasing trend of suicide ideation and attempt, continuous observation and appropriate policy implementation regarding suicide related problems are necessary.
Family Characteristics ; Health Surveys ; Korea ; Public Health ; Suicidal Ideation ; Suicide

Suicide has been a long-standing problem for global public health, along with almost 800,000 deaths from suicide worldwide in 2016, accounting for 1.4% of all deaths. South Korea was ranked first in suicide mortality in 2018 among countries in the Organization for Economic Cooperation and Development. This study aimed to suggest up-to-date information about suicide-related indicators such as the rate of suicidal ideation, suicide attempt, and suicide death, and its trends by applying sampling weight to make it nationally representative. In this study, we used the data sources: Korea National Health and Nutrition Examination (KNHANES, ‘07–13, ‘15–18), Korean Community Health Survey (KCHS, ‘08–09, ‘13, ‘17), Korean Wealth Panel Study (KOWEPS, ‘12–18), Korea Health Panel Survey (KHP, ‘10–13), and Statistics Korea (1983–2017). The rate of suicidal ideation as recent year was 4.73% (KNHANES, ‘17), 6.96% (KCHS, ‘17), 2.29% (KOWEPS, ‘18), and 5.39% (KHP, ‘13). That of suicide attempt as recent year was 0.51% (KNHANES, ‘18), 0.32% (KCHS, ‘17), and 0.15% (KOWEPS, ‘18). Annual percentage change (APC) of suicidal ideation was -15.4% (KNHANES, ‘07–13, ‘15, ‘17), -2.5% (KCHS, ‘08–09, ‘13, ‘17), -10.8% (KOWEPS, ‘12–18), and -10.9% (KHP, ‘10–13). APC of suicide attempt was -4.4% (KNHANES, ‘07–13, ‘15-18), -4.4% (KCHS, ‘08–09, ‘13, ‘17), and -13.6% (KOWEPS, ‘12–18). APC of death by intentional self-harm was -1.25% (Statistics Korea, ‘07–18). All suicide-related indicators were found to be decreasing in the overall from 2009. Individuals with lower income level were more likely to experience suicidal ideation and suicide attempts. Even though suicide rate had been continuously decreasing from its highest point in 2011 (suicide rate: 31.7 per 100,000 population) to 2017 (suicide rate: 24.3 per 100,000 population), it increased again in 2018 (suicide rate: 26.6 per 100,000 population). This information would be grounded on policy implementation for suicide prevention, thus continuous data observation is necessary.

OBJECTIVE: To investigate the clinical feasibility of a newly developed, portable, gait assistive robot (WA-H, ‘walking assist for hemiplegia’) for improving the balance function of patients with stroke-induced hemiplegia. METHODS: Thirteen patients underwent 12 weeks of gait training on the treadmill while wearing WA-H for 30 minutes per day, 4 days a week. Patients' balance function was evaluated by the Berg Balance Scale (BBS), Fugl-Meyer Assessment Scale (FMAS), Timed Up and Go Test (TUGT), and Short Physical Performance Battery (SPPB) before and after 6 and 12 weeks of training. RESULTS: There were no serious complications or clinical difficulties during gait training with WA-H. In three categories of BBS, TUGT, and the balance scale of SPPB, there was a statistically significant improvement at the 6th week and 12th week of gait training with WA-H. In the subscale of balance function of FMAS, there was statistically significant improvement only at the 12th week. CONCLUSION: Gait training using WA-H demonstrated a beneficial effect on balance function in patients with hemiplegia without a safety issue.
Gait* ; Hemiplegia ; Humans ; Rehabilitation* ; Robotics ; Stroke

PURPOSE: This study aims to investigate the actual compliance with chemotherapy and analyze several factors affecting the compliance in patients with gastric cancer. METHODS: From February 2012 to December 2014, we collected data of patients with gastric cancer who received adjuvant chemotherapy (TS-1 monotherapy or XELOX: capecitabine/oxaliplatin) in Korea. RESULTS: We collected data of 1,089 patients from 31 institutions. The completion rate and dose reduction rate by age (≥60 years vs. <60 years) were 57.5% vs. 76.8% (P < 0.001) and 17.9% vs. 21.3% (P = 0.354); by body mass index (BMI) (≥23 kg/m2 vs. <23 kg/m2) were 70.2% vs. 63.2% (P = 0.019) and 19.2% vs. 19.9% (P = 0.987), respectively. The compliance by American Society of Anesthesiologists physical status (ASA PS) classification was as follows: completion rate was 74.4%, 62.8%, and 60% (P = 0.001) and the dose reduction rate was 18.4%, 20.7%, and 17.8% (P = 0.946) in ASA PS classification I, II, and III, respectively. The completion rate of TS-1 and XELOX was 65.9% vs. 70.3% (P = 0.206) and the dose reduction rate was 15.7% vs. 33.6% (P < 0.001). Furthermore, the completion rate of chemotherapy by surgical oncologists and medical oncologists was 69.5% vs. 63.2% (P = 0.028) and the dose reduction rate was 17.4% vs. 22.3% (P = 0.035), respectively. CONCLUSION: The compliance was lower in patients who were older than 60 years, had BMI <23 kg/m2, and had higher ASA PS classification. Furthermore, the patients showed higher compliance when they received chemotherapy from surgical oncologists rather than from medical oncologists.
Body Mass Index ; Chemotherapy, Adjuvant ; Classification ; Compliance ; Drug Therapy ; Humans ; Korea ; Stomach Neoplasms

OBJECTIVE: To determine whether there was a difference in balance, proprioception, and skeletal muscle mass among patients who undergo hip fracture surgery relative to and elective total hip replacement (THR). METHODS: Thirty-one THR patients were enrolled. The patients were categorized into two groups: fracture group (n=15) and non-fracture group (n=16). Berg Balance Scale (BBS) was used to balance the proprioception of the hip joint while a joint position sense (JPS) test was used to evaluate it. Skeletal muscle mass was measured by bioelectrical impedance analysis and expressed as a skeletal muscle mass index (SMI). Quality of life (QOL) was also assessed using a 36-item short form health survey (SF-36). All tests were assessed at 3 months after the surgery. An independent t-test was used to compare the fracture group and non-fracture group. Spearman correlation was used to identify the correlation of each variable. RESULTS: In an independent t-test, the BBS score of patients undergoing elective surgery was higher than the BBS score of patients undergoing hip fracture surgery. There was a significant correlation between the BBS and JPS score after a THR. SMI also correlated with the score of BBS. CONCLUSION: It seems that THR patients undergoing surgery for a hip fracture might have more trouble balancing than elective THR patients. Therefore THR patients undergoing hip fracture surgery might need more care during rehabilitation.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Electric Impedance ; Health Surveys ; Hip ; Hip Joint ; Humans ; Joints ; Muscle, Skeletal* ; Pilot Projects* ; Postural Balance ; Proprioception* ; Quality of Life ; Rehabilitation

PURPOSE: The surgical outcomes of end-stage renal disease (ESRD) patients undergoing radical gastrectomy for gastric cancer were inferior compared with those of non-ESRD patients. This study aimed to evaluate the short- and long-term surgical outcomes of ESRD patients undergoing laparoscopic gastrectomy (LG) and open gastrectomy (OG) for gastric cancer. MATERIALS AND METHODS: Between 2004 and 2014, 38 patients (OG: 21 patients, LG: 17 patients) with ESRD underwent gastrectomy for gastric cancer. Comparisons were made based on the clinicopathological characteristics, surgical outcomes, and long-term survival rates. RESULTS: No significant differences were noted in the clinicopathological characteristics of either group. LG patients had lower estimated blood loss volumes than OG patients (LG vs. OG: 94 vs. 275 mL, P=0.005). The operation time and postoperative hospital stay were similar in both the groups. The postoperative morbidity for LG and OG patients was 41.1% and 33.3%, respectively (P=0.873). No significant difference was observed in the long-term overall survival rates between the 2 groups (5-year overall survival, LG vs. OG: 82.4% vs. 64.7%, P=0.947). CONCLUSIONS: In ESRD patients, LG yielded non-inferior short- and long-term surgical outcomes compared to OG. Laparoscopic procedures might be safely adopted for ESRD patients who can benefit from the advantages of minimally invasive surgery.
Gastrectomy* ; Humans ; Kidney Failure, Chronic* ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Renal Insufficiency ; Stomach Neoplasms* ; Survival Rate